Cardiomyopathies Flashcards
What are the general classifications of cardiomyopathies?
Primary – due to an idiopathic process effecting the myocardium. Secondary – related to a specific heart muscle disease
What are the functional classifications of cardiomyopathies?
Dilatated: ventricular enlargement and systolic dysfunction. Hypertrophic: inappropriate myocardial hypertrophyin the absence of HTN or aortic stenosis. Restrictive: abnormal filling and diastolic function
What is dilated cardiomyopathy?
Ventricles stretch and become flabby and the myocardium deteriorates. Systolic dysfunction and pump failure with low cardiac output.
What is the pathophysiology of dilated cardiomyopathy?
The heart’s attempt to work harder results in increasing levels of Ca2+ in the cardiac cells. This activates a calcium-sensitive enzyme initiating a cascade which switches on genes that cause heart enlargement
How do you differentiate dilated cardiomyopathy and dilated left ventricle due to severe CAD?
Usually post MI - local dysfunction, Dilated myopathy - global dysfunction
What is the clincial presentation of IDCM?
Heart failure symptoms, Anginal chest pain, Emboli, Syncope, Sudden cardiac death and Arhythmias
How is dilated cardiomyopathy diagnosed?
CXR- enlarged heart, biventricular enlargement, and pulmonary vascular congestion. EKG- LVH, Left atrial enlargement, Q waves, poor R wave progression, Afib. Echo: ventricular enlargement, increased systolic and diastolic volumes, decreased EF
What is treatment for DCM?
Limit activity, Salt restriction, Fluid restriction. Medical: ACE inhibitors, diuretics, digoxin, hydralazine / nitrate combination, Anticoagulants, Anti-arrhythmics
What is peripartum cardiomyopathy?
Ventricular dysfuntion developing in the last month before delivery to 5 months postpartum
What are risk factors for peripartum cardiomyopathy?
Advanced maternal age, African-American race, Multifetal pregnancies, Preeclampsia, Gestational HTN
What is hypertrophic cardiomyopathy?
Inappropriate, asymmetric myocardial hypertrophy. Septum is usual site for hypertrophy. Cells with bizarre appearance. autosomal dominant and most common cause of young sudden cardiac death
What is the suggested pathology of hypertrophic cardiomyopathy?
Normal myocytes react to excessive mechanical loads with the release of autocrine growth factors. In HCM, normal systolic pressures sensed by abnormal myocyte as excessive load, initiating further hypertrophy. Sarcomeric dysfunction
What are symptoms of hypertrophic cardiomyopathy?
HTN, dyspnea on exertion, angina like chest pain, palpitations, syncope, sudden death
What will you find on physical exam with hypertrophic cardiomyopathy?
Apex localized, Palpable S4, Harsh systolic ejection murmur across entire precordium → apex & heart base
What are the cardiac findings associated with hypertrophic cardiomyopathy?
LVH. deep and narrow Q waves. Asymmetric septal thickening. Systolic anterior motion of anterior mitral leaflet. Ejection murmur LSB. Often mitral regurg murmur. S4
What is the management for hypertrophic cardiomyopathy?
All first degree relatives: screening echocardiography/genetic counseling. Avoid competitive athletic/discourage rigorous exercise. Holter x 48 hours (sudden death comes from arrhythmias)
What is the medical treatment for hypertrophic cardiomyopathy?
Vasodilators, Inotropes, Diuretics, B-blockers for longer diastolic filling time
What is treatment for non responsive hypertrophic cardiomyopathy?
Surgery (Myotomy/Myectomy), ICD, DDD pacemaker, Non-surgical septal reduction
What is restrictive cardiomyopathy?
Diastolic dysfunction: the ventricular walls are excessively rigid & impede ventricular filling. Myocardial fibrosis, hypertrophy, or infiltration due to variety causes. The atria frequently become enlarged
What can cause restrictive cardiomyopathy?
Deposition of abnormal substances in the myocardium. Infiltrative disease: the abnormal substance is largely between the myocytes–>Amyloidosis, Sarcoidosis. Endomyocardial: fibrosis or radiation
What are clinical features of restrictive cardiomyopathy?
Exercise intolerance & dyspnea, dependent edema, ascites, anasarca, enlarged, tender, & often pulsatile liver. Jugular venous distension, S3, S4
What is used for diagnosis or restrictive cardiomyopathy?
CXR-signs of CHF without cardiomegaly. EKG-nonspecific changes most likely. ECHO-thickened LV walls with normal or slightly decreased volume
What is amyloid heart disease?
Thickened, firm, rubbery ventricular muscle. Major diastolic dysfunction. Abnormal Q waves – look like an M.I. Conduction disturbances, arrhythmias. thickened walls everywhere
What is the treatment for amyloid heart disease?
Drug therapy must be used with caution diuretics for extremely high filling pressures. Vasodilators may decrease filling pressure. Calcium channel blockers to improve diastolic compliance
What is myocarditis?
Involvement of the heart with an inflammatory process. Direct damage, toxins, or immunologic response. North America: viral. South America: Trypanosoma cruzi
What are the findings in myocarditis?
Cardiac symptoms and signs following flu like syndrome. Fatigue, dyspnea, palpitations. Pericardial angina-like pain. Tachycardia. S3 and mitral regurg murmur. Severe = congestive heart failure
What is treatment for myocarditis?
Bed rest. If CHF evident: diuretics, oxygen, inotropes like digoxin
